Understanding The APGAR Score (For Parents)

Immediately after a baby is born, a nurse or doctor often announces a number. This number is referred to as the APGAR score. If you’re about to have a baby, it’ll be useful to understand the meaning behind APGAR score values. Learn more about it here. 

APGAR Score Meaning

Firstly, know that APGAR is actually an acronym. It stands for: appearance, pulse, grimace, activity, respiration. Let’s discuss each below. 

Appearance

Immediately after birth, the nurse has to assess the baby’s appearance, mainly, their color. The values behind the scores are as follows:

• 2: The baby has normal color all over the body and their hands and feet are pink. 
• 1: The baby has normal color, but their hands and feet are bluish. 
• 0: The newborn is pale or bluish-gray all over. 

Pulse 

The second point of assessment in the APGAR score is pulse or heart rate. The healthcare practitioner scores it as follows:

• 2: The baby has a normal pulse: above 100 beats per minute. 
• 1: Pulse is less than 100 beats per minute. 
• 0: The baby has no pulse. 

Grimace

Grimace may seem a little strange to include in the APGAR score. But it doesn’t just point to the baby’s usually sour expression right after being born. Grimace pertains to the baby’s reflex irritability. 

The meanings behind the scores are:

• 2: The baby shows irritability upon stimulation. Your baby may cough, sneeze, pull away, and vigorously cry. 
• 1: The baby shows grimace upon stimulation, but nothing else. 
• 0: The baby has no response to stimulation. 

Activity

A healthy baby is active right after being born. Activity in APGAR score indicates muscle tone. The scores are as follows:

• 2: The baby moves spontaneously and actively. 
• 1: Muscle tone is present, but you can mostly only see it in the flexing (little movement) of arms and legs.
• 0: The baby has no muscle tone. This translates to muscles that are loose and floppy. 

Respiration

And finally, we have R for respiration. The scores are:

• 2: If the baby cries well or vigorously. 
• 1: The breathing is slow or irregular and the baby has weak cries. 
• 0: The baby isn’t breathing. 

Adding and Interpreting the Scores

Healthcare practitioners usually assess the APGAR score twice. Once a minute after birth and then 5 minutes later. The scores on the first minute is indicative of how well the baby tolerates the birthing process. The scores on the fifth minute checks how well the baby is coping outside the mother’s womb. 

Basically, the nurse adds the scores of each area (highest 10). A score of 7 and up is considered good, but getting a lower score (particularly in the first minute) doesn’t necessarily mean that your baby is unhealthy. It might only mean that the baby needs more time to “adjust.”

Of course, if the score remains low, that could indicate that the baby needs medical treatment. For instance, a baby with difficulty breathing might need suctioning to remove excess mucous. 

Does the APGAR Score “Predict” the Baby’s Future Health?

Before we answer this question, please note that perfectly healthy babies may have low APGAR scores in the first few minutes of life. 

However, the American College of Obstetricians and Gynecologists say there might be an association between a low 5-minute score and the risk of cerebral palsy. They mentioned that babies with low scores at the 5-minute mark have 20-100x increased risk compared to infants with a score of 7 to 10. 

At the end of the day, healthcare professionals DO NOT use the APGAR score to predict the baby’s future and long-term health. 

Key Takeaways

The APGAR score, which stands for appearance, pulse, grimace, activity, and respiration, gives an overview of how well the baby tolerates the birthing process and the life outside their mother’s womb. It is, however, not indicative of their future and long-term health.

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